Basic Information
Provider Information
NPI: 1790204188
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAVINSKY
FirstName: SIGNEY
MiddleName: CAMERON
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6300 HACKNEY PL
Address2:  
City: NORTH CHESTERFIELD
State: VA
PostalCode: 232344514
CountryCode: US
TelephoneNumber: 8048320354
FaxNumber:  
Practice Location
Address1: 1000 OLD DENBIGH BLVD STE 1020A
Address2:  
City: NEWPORT NEWS
State: VA
PostalCode: 236022017
CountryCode: US
TelephoneNumber: 7578752009
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/17/2017
LastUpdateDate: 04/10/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X0024175361VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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